About this video
Choosing how to sample a pigmented lesion is far from a one-size-fits-all decision. In this presentation, John R. Griffin, MD, MA, FAAD, reviews how lesion size, anatomic site, and clinical concern should shape the biopsy plan, from removing smaller suspicious lesions in their entirety to using multiple punch samples for larger lesions and selecting a punch approach for acral pigmentation. He also walks through the added complexity of longitudinal melanonychia, where the width and location of the band help determine whether a matrix punch, matrix shave, or lateral longitudinal excision is most appropriate. The session closes with an important reminder that melanoma diagnosis depends on the full architectural, epidermal, dermal, and cytologic picture, sometimes supported by immunohistochemistry or molecular testing, because individual histologic features may also appear in benign nevi.